Topic

Michigan

A collection of 504 issues

How to Get Xenpozyme (Olipudase Alfa) Covered by Cigna in Michigan: Complete Appeal Guide with Forms and Timelines

Answer Box: Getting Xenpozyme Covered by Cigna in Michigan Xenpozyme (olipudase alfa-rpcp) requires prior authorization from Cigna for all ASMD cases, with fulfillment through Express Scripts/Accredo specialty pharmacy. First step today: Have your specialist submit the PA form with genetic testing results (biallelic SMPD1 variants) and enzyme activity <

Getting Vigabatrin Covered by Cigna in Michigan: Complete Prior Authorization and Appeals Guide

Answer Box: Quick Path to Vigabatrin Coverage Cigna requires prior authorization for vigabatrin (generic or Sabril) in Michigan. Your neurologist must submit a PA request confirming FDA-approved use (infantile spasms ≤2 years or refractory complex partial seizures ≥2 years), REMS enrollment, and vision monitoring plan. Standard approval takes 1-2 business

How to Get Xywav (Ca/Mg/K/Na oxybates) Covered by Cigna in Michigan: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Xywav Covered by Cigna in Michigan Cigna requires prior authorization for Xywav (Ca/Mg/K/Na oxybates) with mandatory REMS enrollment. The fastest path: (1) Complete REMS certification for both prescriber and patient, (2) Submit PA via CoverMyMeds with sleep study reports and step therapy documentation, (3)

How to Get Kesimpta (Ofatumumab) Covered by Aetna (CVS Health) in Michigan: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Kesimpta Covered by Aetna (CVS Health) in Michigan Aetna (CVS Health) requires prior authorization for Kesimpta (ofatumumab) in Michigan, typically after failure of 2-3 formulary disease-modifying therapies including an interferon or glatiramer acetate. Your neurologist must document relapsing MS diagnosis, prior therapy failures, hepatitis B screening, and

Get Onpattro (Patisiran) Covered by Humana in Michigan: Complete Prior Authorization and Appeal Guide

Quick Answer: Getting Onpattro (Patisiran) Covered by Humana in Michigan Onpattro requires prior authorization from Humana and costs ~$450,000+ annually. Your fastest path: (1) Have your neurologist submit a PA request with genetic testing confirming hATTR-PN, baseline functional assessments, and vitamin A supplementation plan; (2) If denied, file an

How to Get Vyondys 53 (golodirsen) Covered by Aetna CVS Health in Michigan: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Vyondys 53 Covered by Aetna CVS Health in Michigan Aetna CVS Health requires prior authorization for Vyondys 53 (golodirsen) with strict genetic and functional criteria. To get approved in Michigan: (1) Confirm your child has a DMD gene mutation amenable to exon 53 skipping through genetic testing,

How to Get Vitrakvi (Larotrectinib) Covered by Cigna in Michigan: Complete PA Guide and Appeal Scripts

Answer Box: Getting Vitrakvi Covered by Cigna in Michigan Vitrakvi (larotrectinib) requires prior authorization from Cigna for NTRK fusion-positive solid tumors that are metastatic or unresectable. Submit PA via CoverMyMeds or Evicore with molecular pathology report confirming NTRK fusion, oncologist prescription, and tumor staging documentation. If denied, Michigan residents have

Do You Qualify for Busulfex (Busulfan Injection) Coverage by Aetna CVS Health in Michigan? Decision Tree & Next Steps

Answer Box: Quick Eligibility Check Yes, you likely qualify for Busulfex (busulfan injection) coverage by Aetna CVS Health in Michigan if you have: chronic myeloid leukemia (CML) requiring allogeneic stem cell transplant, your doctor prescribes it with cyclophosphamide as conditioning, and you're being treated at an Aetna Institute

How to Get Spinraza (nusinersen) Covered by UnitedHealthcare in Michigan: Complete PA Guide and Appeals Process

Quick Answer: Getting Spinraza Covered by UnitedHealthcare in Michigan UnitedHealthcare requires prior authorization (PA) for Spinraza (nusinersen) with strict genetic and clinical documentation. Submit genetic confirmation of 5q SMA, baseline motor function scores (HFMSE/RULM), and neurologist prescription through the UHC provider portal. If denied, you have 180 days for

Renewing Bavencio (Avelumab) Approval with Blue Cross Blue Shield Michigan: Complete Documentation Guide

Answer Box: Renewing Bavencio Coverage in Michigan Bavencio (avelumab) requires prior authorization renewal from Blue Cross Blue Shield of Michigan through their Oncology Value Management program managed by OncoHealth. Submit renewal requests 30-45 days before your current authorization expires using updated medical necessity documentation, recent imaging results, and treatment response